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Views and Impressions from the 1st World Malaria Congress - Part 1

July 11, 2018 - 06:15 -- Ricardo Ataide

As the first of its kind, the World Malaria Congress was a stunning success. The Congress organizing committee should be very proud. Grant you, it was not perfect, but first times seldom are. There was a certain rush in getting things done, an eagerness to bring to bed groups that should have had a coffee and a walk in the park beforehand in order to get to know each other's language and idiosyncrasies, likes and dislikes. But the reality of it is that things got done. People engaged with each other and held productive discussions on sensitive topics. The private sector, the NGOs, the WHO, representatives of the affected communities, politicians, government workers, money-movers, money-spenders, medical doctors, PhDs, village health volunteers, mosquito-scientists, parasite-scientists, 'what-about-the-host'-scientists, you name it they were there, and they spoke to each other! Certainly, that deserves recognition, and I for one give it. Melbourne will be remembered for that.

Now, let me talk about some of the things that I found interesting in this first WMC.

1- Community involvement: One of the big surprises, for me, to come out of this Congress has to be the voice that civil societies and affected communities are seeking for themselves and their peers. For a long time now, civil society organizations (CSO) have proved to be instrumental in tackling issues like AIDS, TB, certain cancers, etc. Their work has been around for a few years, but to my own surprise, and as was the sentiment that prevailed after the Congress, only now we are embracing Malaria CSO as true partners in this fight. Malaria elimination efforts should be conducted always with the help, knowledge, and approval of the civil societies affected by the disease. There was unanimous agreement with this notion from all sectors represented at the Congress. The people that suffer from malaria - claimed their representatives at the Congress - should always be 'in-the-know' when it comes to strategies, actions, or interventions that will affect them. We all agree, surely, that no drug trials, vaccine trials, LLIN distributions, IRS campaigns or other such interventions should be conducted without the participation of the communities. Also, no elimination effort, no hope to find that last host reservoir will ever be achieved without the participation and engagement of the communities. But, is this straightforward? Are roles absolutely defined? From my perspective, both myself and others were left with a couple of questions that no doubt will need to be solved in the coming months as the ideas of the WMC start to mature. The message that the CSO represented at the Congress had well memorized and relentlessly brought home - Power to the People, More Money, Zero Deaths - was often marked by a certain naivety and a lack of either knowledge and/or tolerance towards the science that supports the elimination of Malaria. In a couple of examples of this, we heard extremely eloquent and engaging speakers from CSO, bang the table and demand that scientists get their act together and identify which mosquitoes are carrying the parasite; or how scientists need to learn to create better RDTs; or endlessly call for the affected members of the community to show up because they have no voice while several individuals in the room were from those communities, worked in those communities and have had to deal with malaria episodes themselves. We (the scientific community) know what mosquitos carry the parasite, and we know how RDTs work and what we would need to make them better. But we also know the limitations that that knowledge entails. The CSO engagement with the goal of malaria elimination is a passionate one and will certainly drive us forward in achieving it, however, we need to recognize that there are cracks in their arguments. Exposing a glimpse of frailty in an otherwise strong strategy that the Community representatives mounted at the Congress, Prof John Reeder asked Olivia Ngou Zangue (Deputy Director Africa, Malaria No More) how she would justify her demands for more funding to end malaria once malaria becomes so scarce that it stops being a health concern and malnutrition and diarrheal disease continue to kill children in those communities. Will the communities then continue to demand the end of malaria at the cost of withholding attention, funding and human and material resources to tackle those other issues? Her reply sounded mechanical to me - We need more funding to eliminate malaria once and for all in order to stop the senseless deaths of African children in disadvantaged communities. A well rehearsed and highly relevant reply, yes, but not exactly rich in content and actual solutions. This Congress was fantastic in giving a voice to communities that have not had the chance to be heard as often as they should, and to bring those communities to the attention of the scientific audience at large, and more importantly the big donors, but now we need to work out where and how they will fit into the big scheme of things. I look forward to this discussion.

This article represents my personal views and not those of the organisation for which I work.